92 Decision Citation: BVA 92-08474
Y92
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 91-46 658 ) DATE
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THE ISSUES
1. Entitlement to service connection for a bilateral foot
disorder.
2. Entitlement to service connection for a personality
disorder.
3. Entitlement to service connection for a bilateral ankle
disorder.
4. Entitlement to service connection for residuals of a
concussion, claimed as headaches and dizziness.
5. Entitlement to service connection for residuals of a
right eye laceration.
6. Entitlement to service connection for varicose veins in
the right lower extremity.
7. Entitlement to an increased rating for post-traumatic
stress disorder, currently evaluated as 10 percent disabling.
8. Entitlement to an increased rating for residuals of a
shell fragment wound to the left thigh, currently evaluated
as 10 percent disabling.
9. Entitlement to a compensable rating for residuals of a
shell fragment wound to the right knee.
10. Entitlement to a compensable rating for residuals of a
fracture of the fourth metacarpal of the right hand.
11. Entitlement to a compensable rating for residuals of
thrombophlebitis of the right leg.
REPRESENTATION
Appellant represented by: Military Order of the Purple Heart
WITNESS AT HEARING ON APPEAL
The veteran
ATTORNEY FOR THE BOARD
R. L. Shaw, Counsel
INTRODUCTION
The veteran had active military service from January 1944 to
March 1946 and from March 1948 to May 1953.
This matter is before the Board, in part, on appeal from a
December 1990 rating decision of the Seattle, Washington,
Regional Office (RO) of the Department of Veterans Affairs
(VA) which denied the veteran's claim for increased ratings
for various service-connected disabilities. By the same
rating action, service connection was granted for post-
traumatic stress disorder and a 10 percent rating was
assigned; the veteran has appealed the percentage evaluation
assigned. A notice of disagreement dated February 4, 1991,
was received. The case is also on appeal from a rating
decision of April 1991, which denied service connection for
a number of other disorders, including a right eye disorder.
A statement of the case was issued on April 29, 1991. A
substantive appeal (VA Form 1-9) was received from the
veteran on May 21, 1991. A hearing on appeal was held at
the RO on July 25, 1991, before a hearing officer. By a
decision dated August 6, 1991, the hearing officer confirmed
and continued the denials previously entered with respect to
the disorders at issue.
The case was received by the Board of Veterans' Appeals on
October 24, 1991, and docketed on October 25, 1991. The
file was referred to the veteran's representative, the
Military Order of the Purple Heart, on October 29, 1991. An
additional written statement on behalf of the veteran's
appeal dated January 13, 1992, has been received.
REMAND
Shortly after separation from the first period of military
service, by a rating decision of April 1946, the veteran
established service connection for pes planus. The grant
was subsequently severed in 1957; the veteran did not appeal
the severance. A later claim for service connection for
disability of the feet was denied in April 1981 on the basis
that no new and material evidence had been presented. The
rating decision of April 1946 also denied service connection
for disability of the ankles and for a "eye operation." The
veteran did not appeal. The evidence received since the
prior rating decisions regarding all three issues consists
of medical evidence as well as current hearing testimony.
The Board finds that this evidence satisfies the definition
established by the United States Court of Veterans Appeals
for recognition as "new and material" evidence within the
meaning of 38 U.S.C. § 5108 and 38 C.F.R. § 3.156(a).
Consequently, the determination to be made is whether all of
the evidence of record, both old and new, demonstrates that
either a foot disorder, a right eye disorder or an ankle
disorder was incurred in or aggravated by service. Manio v.
Derwinski, U.S. Vet. App. No. 90-86 (February 15, 1991).
With respect to the issues involving psychiatric disability,
the circumstances of this claim raise a question as to
whether the veteran's current adjustment problems result
from post-traumatic stress disorder or from a longstanding
and well documented personality disorder. The veteran
describes personal and occupational adjustment problems
caused by a personality change which he attributes to the
stress and trauma of combat, but the clinical record does
not provide an adequate basis for substantiating his claim
that all of his problems are related to service. The most
recent examination by the VA, performed in October 1990,
confirmed the diagnosis of posttraumatic stress disorder,
but the comments of the examiner do not adequately clarify
the scope of the disorder. Maladjustment due to a personal-
ity disorder may not be considered for rating purposes.
Service connection is in effect for residuals of multiple
small penetrating shell fragment wounds to the left thigh
and right knee; a 10 percent rating is in effect for the
left thigh and a noncompensable rating is in effect for the
right knee. The veteran complains of continuing problems
with the right knee, but the examination of October 1990 did
not contain adequate findings with respect to the left thigh
and did not address the right knee. An additional examina-
tion is required.
The veteran claims that he had trouble with his feet during
service as a result of poorly fitting shoes and that he also
received treatment for problems with the ankles. The Board
believes that an orthopedic examination of the feet and
ankles which conforms to the VA Physician's Guide for
Disability Evaluation Examinations should be conducted
before these issues are adjudicated further. A description
of the current status of the veteran's right hand should be
obtained.
Service medical records show that the veteran was hospital-
ized in 1952 for an episode of erysipelas involving the
anterior surface of the right leg. There was swelling,
tenderness and redness of the anterior midleg with a band of
tenderness extending to the groin. The symptoms were attrib-
uted to acute pyoderma with lymphangitis and lymphadenitis.
A diagnosis of thrombophlebitis of the right leg and thigh
was also made. At the present time, the veteran experiences
pain and tenderness in the right lower extremity, including
in the area of the ankle. However, the picture is clouded
by the fact that he has nonservice-connected varicosities of
both lower extremities. Written clarification in the record
is required as to whether any of the current symptoms result
from the episode of superficial thrombophlebitis in service.
The Board finds that, except with respect to the issue of
entitlement to service connection for a personality disorder,
the claims raised by the veteran are well grounded within
the meaning of 38 U.S.C. § 5107(a) (1991). That is, they
are not inherently implausible or incapable of substantia-
tion. Consequently, the VA has an obligation to assist the
veteran in the development of the evidence regarding such
claims. Accordingly, the case is REMANDED for the following
actions:
1. The RO should arrange for the veteran
to undergo complete psychological testing
by the VA in accordance with the require-
ments of the VA Physician's Guide. A
complete personality profile should be
included.
2. Following completion of the foregoing,
the veteran should undergo a special exam-
ination by a panel of VA psychiatrists to
ascertain the nature and severity of all
current psychiatric pathology. The exami-
nation should be conducted in accordance
with the Physician's Guide. The examiners
should specifically itemize the symptoms
which support the diagnosis of post-
traumatic stress disorder and express an
opinion as to the severity of that condi-
tion. If coexisting psychopathology is
also identified, its manifestations should
be described in detail. The examiners
should also clarify whether avoidant or
explosive behavior on the part of the
veteran results from post-traumatic
stress disorder or from his longstanding
and well documented personality disorder.
It is imperative that the complete claims
folder be made available to the examiners
in connection with this examination.
3. The veteran should undergo a special
orthopedic examination by the VA to
ascertain the nature and severity of all
pathology of the (1) feet, (2) ankles,
(3) shell fragment wound residuals of the
left thigh, (4) shell fragment wound
residuals of the right knee, and
(5) residuals of fracture of the fourth
metacarpal of the right hand. The exam-
ination should be conducted in accordance
with the VA Physician's Guide. All
findings should be set forth in detail.
4. The veteran should undergo an examina-
tion by a specialist in vascular diseases.
The examination should be conducted in
accordance with the VA Physician's Guide.
The examiner should express an opinion as
to whether the veteran has any identifi-
able residuals of the episode of lymphan-
gitis and thrombophlebitis treated in
service. He should indicate whether the
veteran's current symptoms are due to
that episode or to nonservice-connected
varicosities. He should indicate whether
those varicosities are related to the
service connected disability. All
findings should be reported in detail.
6. The veteran should undergo a neuro-
logical examination to ascertain whether
his current headaches are the result of a
concussion during service or are vascular
in nature. The examination should be con-
ducted in accordance with the Physician's
Guide. All findings and conclusions
should be reported in detail.
7. The veteran should undergo a special
eye examination by the VA to ascertain
whether he currently has any defect of
the eye or eyelid related to injuries
claimed to have been incurred during
service. (A July 1944 laceration of the
right upper eyelid is documented.) The
examination should conform to the VA
Physician's Guide. All findings should
be reported in detail.
When the foregoing development has been completed, the claim
should be reviewed by the originating agency. If the
decision remains adverse to the veteran, in whole or in
part, a supplemental statement of the case should be
prepared and the veteran and his representative should be
given a reasonable period of time for reply. Thereafter,
the claim should be returned to the Board for further
review, if in order. No action is required of the veteran
until he receives further notice. The purpose of this
REMAND is to obtain additional information. The Board does
not intimate any factual or legal conclusions as to the
outcome ultimately warranted in this appeal.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DANIEL J. STEIN STEPHEN L. WILKINS
38 U.S.C. § 7102(a)(2)(A) (1991) permits a Board of Veterans'
Appeals Section, upon direction of the Chairman of the
Board, to proceed with the transaction of business without
awaiting assignment of an additional Member to the Section
when the Section is composed of fewer than three Members due
to absence of a Member, vacancy on the Board or inability of
the Member assigned to the Section to serve on the panel.
The Chairman has directed that the Section proceed with the
transaction of business, including the issuance of decisions,
without awaiting the assignment of a third Member.
Under 38 U.S.C. § 7252 (1991), only a decision of the Board
of Veterans' Appeals is appealable to the United States
Court of Veterans Appeals. This remand is in the nature of
a preliminary order and does not constitute a decision of
the Board on the merits of your appeal.